Provider Demographics
NPI:1033482369
Name:A PLACE FOR COMFORT LLC
Entity Type:Organization
Organization Name:A PLACE FOR COMFORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCREASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-831-8502
Mailing Address - Street 1:PO BOX 82542
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9437
Mailing Address - Country:US
Mailing Address - Phone:404-831-8502
Mailing Address - Fax:
Practice Address - Street 1:1766 BIG VALLEY LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5712
Practice Address - Country:US
Practice Address - Phone:678-615-3841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH001362320700000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility